Saturday, May 23, 2015

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La. Medicaid Reform - BAYOU HEALTH

Medicaid Cuts Outlined by DHH, Physicians avoid direct cuts

Today, the Louisiana Department of Health & Hospitals (DHH) and Department of Administration held a joint press conference
to detail the extensive cuts to the state's Medicaid program. Physicians were spared direct cuts to reimbursements, however, the LSMS is concerned about the heavy toll the cuts will have on the state's overall healthcare system.

Other than the 3.7 percent cuts previously announced by DHH as part of the original FY13 state budget starting July 1, physicians will not see any additional cuts to their Medicaid reimbursement. Physicians participating in the Bayou Health Shared Savings plans may realize some indirect reductions. In addition to administrative efficiencies and personnel layoffs, hospitals, nursing homes, emergency medical transportation services will see reductions. Louisiana State University (LSU) Health System will bear the brunt of the cuts. LSMS will continue to monitor the situation and share news with members as the reality of these cuts come to light.

DHH detailed the budget reductions in a news release today:
The cuts were necessary following Congressional action that resulted in a decrease to the state's disaster-recovery Federal Medical Assistance Percentage (FMAP) rate, with the state losing approximately $859.2 million in federal funding. When state general funds are added to the equation, the Medicaid program needs to cut $1.1 billion from it's budget for the next two fiscal years.
Reminder to Providers of Medicaid Check Write Delay This Week
Providers are reminded that this week, the Louisiana Department of Health and Hospitals will not issue checks to Medicaid providers. Providers will be paid for these claims in a double payment that will occur on next week's July 3 check write.
This delay, announced in April, is related to the State's recent move to a 14-day claims payment cycle to incorporate pre-payment claims screening.
Last summer, the State published a new payment calendar for the current fiscal year, including two hold weeks in which no claims were paid, moving Medicaid claims processing to a 21-day cycle. The first hold week occurred during the last week in February, and moved the claims payment cycle from 7 to 14 days. Working with the Medicaid fiscal intermediary, Molina, DHH determined that an additional seven days were not necessary to implement the pre-payment review process.
Because DHH's appropriation for the current fiscal year, which ends June 30, was set based on the planned transition to the 21-day cycle, thedepartment will delay claims payments this week, with no usual Tuesday check write today.
However, providers will receive payment for this week's claims along with next week's claims in the first check write of the next fiscal year, which occurs July 3, 2012. Weekly payments in the next fiscal year will then resume on a 14-day processing cycle.
Changes to the check write schedule are unrelated to the three BAYOU HEALTH Plans - Amerigroup, LaCare and Louisiana Healthcare Connections - that handle their own claims processing and payment. The other two BAYOU HEALTH Plans, Community Health Solutions and United Healthcare Community Plan, send their claims to Molina for payment, and these Plans will follow the Medicaid program's check write schedule.The changes also do not affect the payment schedule for Medicaid specialized behavioral health services through the Louisiana Behavioral Health Partnership, which are paid and processed through Magellan.

Cecilia McNeil, chief of operations and finance for the Guidance Center, a mental health rehabilitation (MHR) center located in a Chalmette strip mall, apologizes for the clutter in her second-story office — two times. The "mess" is forgivable. But cleaning up the folders on her desk isn't her biggest problem at the moment.

McNeil turns on her computer and loads up Clinical Advisor, a Medicaid reimbursement computer program built by state contractor Magellan Health Services that was supposed to make life easier for her and her husband Michael, the company's CEO. The Guidance Center employs 80 clinical and support staff providing rehabilitative treatment to nearly 680 clients, many with severe, chronic mental illness, and 95 percent of their clients use Medicaid.
Clinical Advisor is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It's not working. As a result, providers — many of which, like the Guidance Center, serve Medicaid clients — haven't been able to submit Medicaid claims. What's more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid. And the McNeils have had to cut back.
Read the full story at The Gambit.
Are Medicaid coordinated care networks working?  Check the following link to the DHH website for the most recent update on the Bayou Health pilot project.  Please let the LSMS know if you are experiencing any Medicaid reimbursement issues.   
A link to the CCN handbooks can be found on the Making Medicaid Better website by clicking here.

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